ALERTS, NOTICES, AND CASE REPORTS
656 19. Harris RI: Polyostotic fibrous dysplasia with acromegaly. Am J Med 1985; 78:539-542 20. Joishy SK, Morrow LB: McCune-Albright syndrome associated with a functioning pituitary chromophobe adenoma. J Pediatr 1976; 89:73-75 21. Pbwell DGB: Polyostotic fibrous dysplasia with acromegaly (Albright's syndrome). South Afr Med J 1976; 50:182-183 22. Lightner ES, Winter JSD: Treatment of juvenile acromegaly with bromocriptine. J Pediatr 1981; 98:494-496 23. Polychronakos C, Tsoukas G, DucharmeJR, LetarteJ, Collu R: Gigantism and hyperprolactinemia in polyostotic fibrous dysplasia (McCune-Albright syndrome). J Endocrinol Invest 1982; 5:323-326 24. Cuttler L, Levitsky LL, Zafar MS, Mellinger RC, Frohman LA: Hypersecretion of growth hormone and prolactin in McCune-Albright syndrome (Abstr). Pediatr Res 1986; 20:213A 25. Geffner ME, Nagel RA, Dietrich RB, Kaplan SA: Treatment of acromegaly with a somatostatin analog in a patient with McCune-Albright syndrome. J Pediatr 1987; 111:740-743 26. Pacini F, Perri G, Bagnolesi P, Cilotti A, Pinchera A: McCune-Albright syndrome with gigantism and hyperprolactinemia. J Endocrinol Invest 1987; 10:417-420 27. Franks S: Male reproductive endocrinology. Clin Obstet Gynaecol 1980; 8:549-569 28. Wu FCW: Male hypogonadism-Current concepts and trends. Clin Obstet Gynaecol 1985; 12:531-555 29. Griffin JE, Wilson JD: Disorders of the testes and male reproductive tract, In Wilson JD, Foster DW (Eds): Williams Textbook of Endocrinology, 7th edition. Philadelphia, Pa, WB Saunders, 1985, pp 259-311 30. Carter JN, Tyson JE, Tolis G, Van Vliet S, Faiman C, Friesen HG: Prolactin-secreting tumors and hypogonadism in 22 men. N Engl J Med 1978; 299:847852 31. Mawhinney MG, BelisJA, Thomas JA, et al: Effect of prolactin on androgen metabolism by the guinea-pig sex accessory organs. J Pharmacol Exp Ther 1975; 192:242-249 32. Magrini G, Ebiner JR, Burckhardt P, et al: Study on the relationship between plasma prolactin levels and androgen metabolism in man. J Clin Endocrinol Metab 1976; 43:944-947 33. Zini D, Carani C, Baldini A, Cavicchioli C, Piccinini D, Marrama P: Further acquisitions on gonadal function in bromocriptine treated hyperprolactinemic male patients. Pharmacol Res Commun 1986; 18:601-609 34. Baumann G: Acromegaly. Endocrinol Metab Clin 1987; 16:685-703 35. Cuttler L, Jackson JA, Saeed uz-Zafer M, Levitsky LL, Mellinger RC, Frohman LA: Hypersecretion of growth hormone and prolactin in McCuneAlbright syndrome. J Clin Endocrinol Metab 1989; 68:1148-1154 36. Lee PA, Van Dop C, Migeon CJ: McCune-Albright syndrome: Long-term follow-up. JAMA 1986; 256:2980-2984 37. Levine MA, Jap TS, Mauseth RS, Downs RW, Spiegel AM: Activity of the stimulatory guanine nucleotide-binding protein is reduced in erythrocytes from patients with pseudohypoparathyroidism and pseudopseudohypoparathyroidism: Biochemical, endocrine, and genetic analysis of Albright's hereditary osteodystrophy in six kindreds. J Clin Endocrinol Metab 1986; 62:497-502
Revenge of the Barbecue Grill Carbon Monoxide Poisoning JOHN D. GASMAN, MD JOSEPH VARON, MD JAMES P. GARDNER, MD Stanford, California
CARBON MONOXIDE (CO) poisoning can be difficult to recognize because it often has a presentation that suggests a viral illness, food poisoning, gastroenteritis, or even a functional illness. Because CO is the leading cause of death due to poisoning in the United States,1-3 emergency department physicians should suspect CO poisoning when a similar illness occurs simultaneously in two or more persons.
Report of Cases Four members of a non-English-speaking family presented to a university hospital emergency department, all (Gasman JD, Varon J, Gardner JP: Revenge of the barbecue grillCarbon monoxide poisoning. West J Med 1990 Dec; 153:656-657) From the Department of Medicine, Stanford University Medical Center (Drs Gasman and Varon), and the Division of Emergency Medicine, Department of Stanford University School of Medicine (Dr Gardner), Stanford, CaliforSurgery, nia. Reprint requests to John D. Gasman, MD, Department of Medicine S-102D, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305.
complaining of headache, lethargy, abdominal cramping, and nausea. They related a history of drinking unrefrigerated milk the evening before presentation. Two patients had mild orthostatic blood pressure changes. They were treated with intravenous fluids and discharged with the diagnosis of infectious gastroenteritis. One family member remained in the emergency department with persistent symptoms. Several hours later, four other members of the same family presented to the emergency department with similar complaints. They were evaluated and treated with intravenous fluids, and all were discharged, including the patient from group 1. Several hours later, four more members of the same family presented to the emergency department with similar complaints. One patient had not ingested the suspected milk, but she suffered from migraine headache and thought that this was one of her headaches. Further questioning through an interpreter revealed that all patients were members of the same household. Specific questions about home heating systems did not suggest mechanical problems; in fact, it had not been used. An unaffected relative, who lived elsewhere, admitted to cooking indoors with charcoal briquets in the fireplace after originally stating that the cooking was done outdoors. Specimens were drawn for arterial blood gas determinations and carboxyhemoglobin (COHb) concentrations. Results were 0.069, 0.151, 0.171 and 0.174 (normal
656 19. Harris RI: Polyostotic fibrous dysplasia with acromegaly. Am J Med 1985; 78:539-542 20. Joishy SK, Morrow LB: McCune-Albright syndrome associated with a functioning pituitary chromophobe adenoma. J Pediatr 1976; 89:73-75 21. Pbwell DGB: Polyostotic fibrous dysplasia with acromegaly (Albright's syndrome). South Afr Med J 1976; 50:182-183 22. Lightner ES, Winter JSD: Treatment of juvenile acromegaly with bromocriptine. J Pediatr 1981; 98:494-496 23. Polychronakos C, Tsoukas G, DucharmeJR, LetarteJ, Collu R: Gigantism and hyperprolactinemia in polyostotic fibrous dysplasia (McCune-Albright syndrome). J Endocrinol Invest 1982; 5:323-326 24. Cuttler L, Levitsky LL, Zafar MS, Mellinger RC, Frohman LA: Hypersecretion of growth hormone and prolactin in McCune-Albright syndrome (Abstr). Pediatr Res 1986; 20:213A 25. Geffner ME, Nagel RA, Dietrich RB, Kaplan SA: Treatment of acromegaly with a somatostatin analog in a patient with McCune-Albright syndrome. J Pediatr 1987; 111:740-743 26. Pacini F, Perri G, Bagnolesi P, Cilotti A, Pinchera A: McCune-Albright syndrome with gigantism and hyperprolactinemia. J Endocrinol Invest 1987; 10:417-420 27. Franks S: Male reproductive endocrinology. Clin Obstet Gynaecol 1980; 8:549-569 28. Wu FCW: Male hypogonadism-Current concepts and trends. Clin Obstet Gynaecol 1985; 12:531-555 29. Griffin JE, Wilson JD: Disorders of the testes and male reproductive tract, In Wilson JD, Foster DW (Eds): Williams Textbook of Endocrinology, 7th edition. Philadelphia, Pa, WB Saunders, 1985, pp 259-311 30. Carter JN, Tyson JE, Tolis G, Van Vliet S, Faiman C, Friesen HG: Prolactin-secreting tumors and hypogonadism in 22 men. N Engl J Med 1978; 299:847852 31. Mawhinney MG, BelisJA, Thomas JA, et al: Effect of prolactin on androgen metabolism by the guinea-pig sex accessory organs. J Pharmacol Exp Ther 1975; 192:242-249 32. Magrini G, Ebiner JR, Burckhardt P, et al: Study on the relationship between plasma prolactin levels and androgen metabolism in man. J Clin Endocrinol Metab 1976; 43:944-947 33. Zini D, Carani C, Baldini A, Cavicchioli C, Piccinini D, Marrama P: Further acquisitions on gonadal function in bromocriptine treated hyperprolactinemic male patients. Pharmacol Res Commun 1986; 18:601-609 34. Baumann G: Acromegaly. Endocrinol Metab Clin 1987; 16:685-703 35. Cuttler L, Jackson JA, Saeed uz-Zafer M, Levitsky LL, Mellinger RC, Frohman LA: Hypersecretion of growth hormone and prolactin in McCuneAlbright syndrome. J Clin Endocrinol Metab 1989; 68:1148-1154 36. Lee PA, Van Dop C, Migeon CJ: McCune-Albright syndrome: Long-term follow-up. JAMA 1986; 256:2980-2984 37. Levine MA, Jap TS, Mauseth RS, Downs RW, Spiegel AM: Activity of the stimulatory guanine nucleotide-binding protein is reduced in erythrocytes from patients with pseudohypoparathyroidism and pseudopseudohypoparathyroidism: Biochemical, endocrine, and genetic analysis of Albright's hereditary osteodystrophy in six kindreds. J Clin Endocrinol Metab 1986; 62:497-502
Revenge of the Barbecue Grill Carbon Monoxide Poisoning JOHN D. GASMAN, MD JOSEPH VARON, MD JAMES P. GARDNER, MD Stanford, California
CARBON MONOXIDE (CO) poisoning can be difficult to recognize because it often has a presentation that suggests a viral illness, food poisoning, gastroenteritis, or even a functional illness. Because CO is the leading cause of death due to poisoning in the United States,1-3 emergency department physicians should suspect CO poisoning when a similar illness occurs simultaneously in two or more persons.
Report of Cases Four members of a non-English-speaking family presented to a university hospital emergency department, all (Gasman JD, Varon J, Gardner JP: Revenge of the barbecue grillCarbon monoxide poisoning. West J Med 1990 Dec; 153:656-657) From the Department of Medicine, Stanford University Medical Center (Drs Gasman and Varon), and the Division of Emergency Medicine, Department of Stanford University School of Medicine (Dr Gardner), Stanford, CaliforSurgery, nia. Reprint requests to John D. Gasman, MD, Department of Medicine S-102D, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305.
complaining of headache, lethargy, abdominal cramping, and nausea. They related a history of drinking unrefrigerated milk the evening before presentation. Two patients had mild orthostatic blood pressure changes. They were treated with intravenous fluids and discharged with the diagnosis of infectious gastroenteritis. One family member remained in the emergency department with persistent symptoms. Several hours later, four other members of the same family presented to the emergency department with similar complaints. They were evaluated and treated with intravenous fluids, and all were discharged, including the patient from group 1. Several hours later, four more members of the same family presented to the emergency department with similar complaints. One patient had not ingested the suspected milk, but she suffered from migraine headache and thought that this was one of her headaches. Further questioning through an interpreter revealed that all patients were members of the same household. Specific questions about home heating systems did not suggest mechanical problems; in fact, it had not been used. An unaffected relative, who lived elsewhere, admitted to cooking indoors with charcoal briquets in the fireplace after originally stating that the cooking was done outdoors. Specimens were drawn for arterial blood gas determinations and carboxyhemoglobin (COHb) concentrations. Results were 0.069, 0.151, 0.171 and 0.174 (normal
